Teleconsultation to improve healthcare delivery (1)

A recent article in MI suggests that the Health Care sector needs to radically innovate in order to improve the efficiency of healhcare delivery to meet the challenges of the 21st century. The recurring theme in the article seemed to be that some form of Teleconsultation could take the place of traditional office visits in certain circumstances.
Taking an hour drive to a clinic or hospital, finding a car park, waiting in the clinic, followed by more queuing for your medicines could be a thing of the past if Teleconsultation could be applied where appropriate.

For example, a chronic illness like Hypertension can be largely managed by Teleconsultation, reducing (though not entirely eliminating since face to face consultation and physical examination is needed from time to time) the number of office visits:

Does a stable and well-controlled hypertensive patient need to physically consult her doctor every two or three months? Would a virtual consult or even a computer-augmented self-management regime suffice in between annual visits to her physician?
Years ago, I had the privilege to visit Kaiser Permanente, a world-renowned Californian integrated care provider.
I asked my host: “How often does a well-controlled hypertensive patient need to physically consult?” His response: “Never, we can do everything remotely through the Internet or over the phone.”
He added that during the annual in-person general preventive health screening consultation, high blood pressure control could be discussed. Almost a quarter of the Singapore adult population has high blood pressure. Imagine how many physician visits could be obviated.

Another example quoted is in the field of Dermatology :

Certain specialties such as dermatology are highly visual. Can a dermatologist provide advice remotely to a family physician instead of having the patient moving back and forth, creating additional visits? Sure. In the University of California Davis, dermatologists treat patients from 32 remote sites in California via “live interactive” teledermatology.
In Singapore, 5 per cent of all GP visits are for skin-related ailments. How many progress to specialist referrals, and of these, how many could have been avoided by enlisting teledermatology?

In the above example it is a doctor to doctor consultation, between a GP and a Specialist. This benefits the patient in having the opportunity to get a specialist opinion with the guidance of his primary care doctor – and a quick decision can be made whether or not the patient needs to see the specialist in person.

In Malaysia, there are actually laws in place with regard to Telemedicine, and the Telemedicine Act (PDF link) has been in place since 1997.
The act defines Telemedicine as “the practice of medicine using audio,visual and data communications” which means even the simple act of giving medical advice via the phone or email already constitutes an act of Telemedicine.

The act also requires that Informed Consent needs to be obtained from patients in order to practice Telemedicine, and specially requires that patients be informed:

(a) that he is free to withdraw his consent at any time without affecting his right to future care or treatment;
(b) of the potential risks, consequences and benefits of telemedicine;
(c) that all existing confidentiality protection apply to any information about the patient obtained or disclosed in the course of the telemedicine interaction;
(d) that any image or information communicated or used during or resulting from telemedicine interaction which can be identified as being that of or about the patient will not be disseminated to any researcher or any other person without the consent of the patient

The act also defines who may practice Telemedicine and in fact requires specific “certification” from the Malaysian Medical Council though up until this time, the MMC has not enforced this requirement.

Given the improving penetration of broadband (wired and wireless) in this country and the wide availability of mobile devices with Internet connectivity (smartphones and tablets for instance) the potential for Telemedicine is huge and an under utilised sector. I would consider it the next frontier in Medicine in this country.

The next post will deal with an example of a Malaysian Telemedicine service provider which will easily connect Patients and Doctors.